Li Hu,Chao Min,Jiang Jiabin,et al.Analysis of risk factors of unplanned reoperation after laparoscopic pyeloplasty[J].Journal of Clinical Pediatric Surgery,2024,(04):328-334.[doi:10.3760/cma.j.cn101785-202403060-006]
腹腔镜肾盂成形术后非计划再手术的危险因素分析
- Title:
- Analysis of risk factors of unplanned reoperation after laparoscopic pyeloplasty
- Keywords:
- Ureteropelvic Junction Obstruction; Laparoscopy; Pyeloplasty; Postoperative Complications; Reoperation; Root Cause Analysis; Child
- 摘要:
- 目的 探讨肾盂输尿管连接处梗阻(ureteropelvic junction obstruction,UPJO)患儿腹腔镜肾盂成形术(laparoscopic pyeloplasty,LP)后非计划再手术(unplanned reoperation,UR)的危险因素。 方法 回顾性分析2010年3月至2023年12月安徽省儿童医院收治的因单侧UPJO首次行LP患儿的临床资料。将LP术后发生UR的患儿纳入病例组,未发生UR的患儿纳入对照组,收集两组患儿性别、年龄、肾造瘘病史、术前肾盂直径、美国胎儿泌尿外科协会(Society of Fetal Urology,SFU)分级、手术者经验、术后住院时间等,对非计划再手术的危险因素进行单因素及多因素Logistic回归分析。同期收集UR患儿第二次手术时的临床及影像学资料,进一步分析发生UR患儿的临床特点。 结果 本研究共纳入678例UPJO患儿,其中19例(2.8%)发生UR。根据第二次手术时间分为近期UR和远期UR,其中近期UR 4例(4/678,0.6%),原因为吻合口漏尿致尿腹和尿囊;远期UR 15例(15/678,2.2%),原因为肾盂输尿管连接处梗阻复发,肾积水加重伴反复腹痛、尿路感染、血尿等。单因素分析结果显示,肾盂直径、术后住院时间、SFU、术者经验、有无肾造瘘病史与UR的发生有关(P＜0.05)。多因素Logistic回归分析显示,肾盂直径长(OR＝1.278,95%CI:1.069~1.528)、术后住院时间长(OR＝1.165,95%CI:1.094~1.239)、术者经验欠缺( OR＝0.226,95%CI:0.070~0.725)及有肾造瘘病史(OR＝17.817,95%CI:3.291~96.446)是UPJO患儿术后发生UR的危险因素。 结论 UPJO患儿肾盂直径、术后住院时间、术者经验以及无肾造瘘病史与UR相关;及时行肾脏超声检查,评估肾脏功能,术中精准操作可减少并发症的发生,也是预防和减少UR发生的重要举措。
- Abstract:
- Objective To explore the risk factors of unplanned reoperation (UR) after laparoscopic pyeloplasty (LP) in children with ureteropelvic junction obstruction (UPJO) and examine the clinical characteristics of UR children. Methods From March 2010 to December 2023,the relevant clinical data were retrospectively reviewed for 678 children of unilateral UPJO undergoing LP.Children undergoing UR after LP were selected as study group and those without UR as control group.Gender,age,history of nephrostomy,Society of Fetal Urology (SFU) grade,surgical proficiency and postoperative hospitalization stay of two groups were collected for univariate and multivariate Logistic regression analyses.Statistical analysis was performed with SPSS version 26.0 software package. Results Among them,19(2.8%) cases underwent UR.According to the timing of reoperation,it was assigned into short-term and long-term URs.Four children (4/678,0.6%) underwent short-term UR for uroabdomen and allantois due to anastomotic leakage,varying degrees of intestinal obstruction and abdominal infection.Long-term UR was performed in 15 children (15/678,2.2%) for recurrent UPJO,aggravation of hydronephrosis,recurrent abdominal pain,urinary tract infection and hematuria.According to univariate analysis,anteroposterior diameter (APD),postoperative hospitalization stay,surgical proficiency,preoperative severity of hydronephrosis and presence of percutaneous nephrostomy were associated with UR (P<0.05).Based upon multivariable analysis,APD (OR=1.278,95%CI:1.069-1.528),postoperative hospitalization stay (OR=1.165,95%CI:1.094-1.239),surgical proficiency (OR=1.165,95%CI:1.094-1.239) and presence of percutaneous nephrostomy (OR=17.817,95%CI:3.291-96.446) were the strongest predictors of UR (P<0.05). Conclusions APD,postoperative hospitalization stay,surgical proficiency and presence of percutaneous nephrostomy are correlated with UR.Timely renal ultrasonography,evaluation of renal function,accurate intraoperative handling and a lowered risk of complications are vital for preventing and minimizing UR.
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备注/Memo
收稿日期:2024-01-21。
基金项目:安徽省科技厅临床医学转化项目(202304295107020066)
通讯作者:张殷,Email:zhangyincx@163.com